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Everything you need to know about Computed Tomography (CT) & CT Scanning


question

Question 18: In this patient with increasing dyspnea what is the best overall diagnosis?

answer

Diagnosis: Chronic SVC Occlusion with Extensive Mediastinal Collaterals

SVC Obstruction: etiology

  • Lung cancer
  • Lymphoma
  • Thymoma
  • Fibrosing mediastinitis (histoplasmosis is most common)
  • Radiation fibrosis
  • Iatrogenic (due to catheter placement)

Collateral pathways are commonly opacified in SVC Syndrome

  • Azygous and hemiazygous system
  • Paravertebral vessels
  • Mediastinal veins as collaterals (as in this case)
  • Anterior intercostal veins
  • Internal mammary veins

 

SVC Syndrome with Stenosis SVC

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Metastatic Renal Cell Carcinoma Invades the SVC

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SVC Encasement by Lung Cancer

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SVC Occlusion and "Hot Spot in the Liver"

  • Originally described on the nuclear medicine literature in the pre-CT days
  • Can simulate a vascular metastases on early phase images of the liver (i.e. looks like a metastatic islet cell or neuroendocrine tumor)
  • Will become isodense on delayed phase images
  • Typical location near falciform ligament
  • A key CT finding suggesting the diagnosis is collaterals in the subcutaneous tissues in the chest or upper abdomen

 

Hot Spot Liver Due to SVC Syndrome

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Collaterals Abdominal Wall and Hot Spot Liver

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© 1999-2019 Elliot K. Fishman, MD, FACR. All rights reserved.